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HomeMy WebLinkAbout51361-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 51361 Date: 11/06/2024 Permission is hereby granted to: IVNN LLC 768 Piermont Ave Piermont, NY 10968 To: Construct an inground swimming pool as applied for per Historic Preservation Commission approval. Pool and pool equipment must maintain a minimum setback of 3 feet. Premises Located at: 585 Orchard St, Orient, NY 11957 SCTM# 25.-2-14.1 Pursuant to application dated 08/23/2024 and approved by the Building Inspector. To expire on 11/06/2026. Contractors: Required Inspections: FOOTING/REBAR, ELECTRICAL- ROUGH, ELECTRICAL- FINAL, DRAINAGE, FINAL, Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total $400.00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT a Town Hall Annex 54375 Main Road P.O.Box 1179 Southold,NY 11971-0959 " g Telephone(631) 765-1802 Fax(631)765-9502 h tp ./lmr°vy&.,Ll lol tokvilrly .,C)v Date Received APPLICATION FOff' , BUILDING PERMIT For Office use Only �PERMIT NO. Building fnspector: 1. 11_U Am" 2 2 2024 Applications and forms must be filled out in their entirety.incomplete applications will not be accepted. Where the Applicant is not the owner,an EI'ullding Department Owner's Authorization form(Page 2)shall be completed. Town of Southold Date:07/16/2024 OWNER(S)OF PROPERTY: Name:IVNN Ilc scrM#ioaa- Project Address:585 Orchard Street, Orient, NY 11957 Phone#:212 518 1818 Email:dsj@snowdon.us Mailing Address:PO BOX 71, Orient, NY 11957 CONTACT PERSON: Name:David Snowdon-Jones - Owner's Agent Mailing Address:PO BOX 71, Orient, NY 11957 Phone#:212 518 1818 ..... Email:dsj@snowdon.uS DESIGN PROFESSIONAL INFORMATION: Name:Snowdon Ltd, David Snowdon-Jones. Agent Mailing Address:PO BOX 71, Orient, NY 11957 Phone#: 2 518 1818 Email:... ..__ CONTRACTOR INFORMATION: ­.M_A^wwwww Name: Mailing AddressP0 Phone#: GB( ' Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addi111"bp� . ton Alteration ❑Repa" ❑Demolition Estimated Cost of Project: (]Other.PSI IL m __ $100,000 Will the lot be re-graded? ❑Yes kNo Will excess fill be removed from premises? BYes ❑No 1 PROPERTY INFORMATION Existing use of property:Private Residence Intended use of property:Private Residence Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to SCTM# 1000-25-2-14.1 this property? ❑Yes iNo IF YES,PROVIDE A COPY. @ Check Roar After Reading.' The owner/wntractor/design professional is responsible for aft drainage and storm water issues as provided by Chapter 236 of the Town Code.APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable taws,ordinances,building code, housing code and regulations and to admit authorized Inspectors on premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law. Application Submitted By(print name):David Snowdon-Janes @Authorized Agent ❑Owner Signature of Applicant: C=t Qt­­. Date: July 16th, 2024 STATE OF NEW YORK) SS: COUNTY OF _ w being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the (Contracto Agen Corporate Officer,etc.} of said owner or owners,and is duly authorized to pe orm or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this ,2 day of � 20 1—a- . otary Public -30TARY0 E5L((,ac:a,a�r: , . :,. PROPERTY OWNER , ORi '' TI (Where the applicant is not the owner) N N N I Ic residing at 585 Orchard Street, Orient, NY 11957 on file at building Department David Snowdon-Jones do hereby authorize ww to apply on my behalf to the Town of Southold Building Department for approval as described herein. July 16th 2024 Owner's Signature Date IVNN Ilc_ Print Owner's Name 2 A David Mammina,Chairperson Town Hall Annex Anne Surchin,Vice Chair' �� � `` 54375 Main Road Marina de Conciliis PO Box 1179 Jeri Woodhouse Southold,NY 11971 Marina deConciliis w Telephone:(631)765-1809 Daryl Ketcham i kimf@southoldtownny.gov Kim E.Fuentes,Coordinator ses+rv101A Town of Southold Historic Preservation Commission Certificate to of Apgropriateness July 25, 2024 RESOLUTION#08.24.2023.1 AMENDED RE: 585 Orchard Street, Orient,NY. SCTM#1000-24-2-14.1 Owner: IN.N.N.,LLC RESOLUTION: WHEREAS; 585 Orchard Street, Orient,NY, is on the Town of Southold Registry of Historic Landmarks;and WHEREAS, as set forth in Section 56-7(b) of the Town Law(Landmarks Preservation Code) of the Town of Southold,all proposals for material change/alteration and additions must be reviewed and granted a Certificate of Appropriateness by the Southold Town Historic Preservation Commission prior to the issuance of a Building Permit; and, WHEREAS, the applicant's representative, David Dafydd Snowdon-Jones,submitted a proposal to construct additions and alterations to a single family dwelling upon residential property listed on the Town of Southold Registry of Historic Landmarks; and WHEREAS, the architectural plans presented to the Commission dated 2023-08-07,issued 2023-07-27, proposing an amendment to the second floor addition of the single family residence in order to comply with side yard setback requirements of the Town Code,replace the foundation,windows and doors of the accessory garage,and the installment of a fence surrounding a swimming pool; and WHEREAS, the proposed plans consist of Green Mountain Egress Windows,Anderson Series A Windows,and Hardie Board Shiplap Smooth Finish Siding, and the proposed fence is described as Square Lattice Cedar Fence Panels by Big Red Cedar;and WHEREAS, pursuant to a review by the Town's Permit Examiner, a Notice of Disapproval was issued on August 14,2023 as the result of the applicant's request for a permit to construct an accessory swimming pool/pool fence and alterations to an existing accessory garage,all of which are subject to the Historic Preservation Commission approval;and WHEREAS, the Commission,on August 24,2023 voted to rescind Certificate of Appropriateness Resolution#07.27.2023.2 for reasons that the design had changed and that the application was deemed incomplete; and Certificate of Appropriateness#08.24.2023.1—AMENDED July 25,2024 HPC,I.V.N.N.585 Orchard Street, SCTM No. 1000-25-2-14.1 WHEREAS, the applicant came before the Commission on August 24,2023 at a public hearing in order to review the proposed changes to the single family dwelling,the accessory structure and the fence surrounding a 12 feet by 20 feet swimming pool;and WHEREAS, the architectural plans of the single family dwelling,the accessory garage and fence dated August 24,2023,issued 2023-08-24, signed and seated by Nicholas J'.Maz7Aferro,LPE, were received by the Commission on September 5,2023 which proposed an amendment to the second floor addition of the single family residence in order to comply with side yard setback requirements of the Town Code,replace the foundation,windows and doors of the accessory garage,and the installment of a fence surrounding a swimming pool;and WHEREAS, as require'd by the Commission,the proposed improvements that are depicted in the aforementioned Plans for a jiMiq-fly—ami, d we_11ing.armedAgg�L��consist of Green -- Mountain Egress Windows,Anderson Series A Windows,and Hardie Board Shiplap Smooth Finish Siding;and WHEREAS, the proposed fence is described as Square Lattice Cedar Fence Panels by Big Red Cedar as indicated in illustrations received on August 28,2023;and WHEREAS2 the applicant shall submit to the Commissioners photographs of the finished Improvements upon completion; and WHEREAS, the Commissioners may conduct a site inspection of subject premises once improvements are completed;and WHEREAS, on August 24,2023,the Southold Town Historic Preservation Commission determined that Site Plan,Elevation Plans,and Architectural Plans of the single family dwelling, accessory garage and fencing prepared by David Dafydd Snowdon-Jones,Architect, signed and sealed by Nicholas I Ma7zaferro,LPE,dated August 24,2023,met the criteria for approval under Section 170-8 (A)of the Southold Town Code;and WHEREAS, on April 25,2024,via email communication,the applicant's representative,David Snowdon-Jones requested an amendment to the subject Certificate of Appropriateness to include,"as built demolition"and the addition of a chimney; and WHEREAS, on July 25,2024,the applicant's representative,David Snowdon presented a revised Site Plan and Architectural Plans,(Sheets T-1.A-1,A-1.1 thru A-1.3,F-1.1,F-1.2,A- 2.2 thru A-2.5)last revised May 29,,.2024,signed and sealed by Nicholas J. Mazzaferro,LPE; and WHEREAS, the proposed brick chimney shall consist of Olde London Brick to match the neighbor's chimney to the west; and WHEREAS, in addition to the aforementioned elements of the architectural plans presented,the applicant has requested approval for a hot tub which will also be enclosed by the approved fence; and Certificate of Appropriateness#08.24.2023.1 —AMENDED July 25,2024 BPC,I.V.N.N. 585 Orchard Street, SCTM No. 1000-25-2-14.1 NOW THEREFORE BE IT RESOLVED,that the Southold Town Historic Preservation Commission determines that the Amended Site Plan,Elevation Plans,and Architectural Plans of the single family dwelling,accessory garage(converted to a cabana/pool house),hot tub,swimming pool and fencing prepared by David Dafydd Snowdon-Jones,Architect,'last revised May 29,2024,signed and sealed by Nicholas J.Mazzaferro,LPE,meets the criteria for approval under Section 170-8(A)of the Southold Town Code; and BE IT FURTHER RESOLVED,that the Commission approves the request for a Certificate of Appropriateness,subject to approvals by all involved agencies;and BE IT FURTHER RESOLVED,that any deviation from the approved plans referenced above,or request for approval of amended/revised plans,shall require a review by the Building Department Permits Examiner,a new application,and a public hearing. Motion made by Commissioner de Conciliis Motion seconded by: Commissioner Woodhouse VOTES:AYES: Commissioners Mammina, Surchin,Wexler,Woodhouse,de Conciliis, and Ketchum. (6-0) RESULT:Passed Please note that that any deviation from the approved plans referenced above, or request for approval of amended/ evited plan.,sha require anew application and a public hearing. 4 Signed: Kim E.Fuentes,Coordinator for the Historic Preservation Commission Date: July 30,2024 Workers' CERTIFICATE OF INSURANCE COVERAGE or 'Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name 8 Address of Insured(use street address only) �'1b.Business Telephone Number of Insured BINDER POOLS INC 631-749-2110 PO BOX 1960 SHELTER ISLAND,NY 11964 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations In New York State,i.e.,wrap-up Policy) 113368250 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold PO Box 1179 3b.Policy Number of Entity Listed in Box"l a" Southold, NY 11971 DBL397420 3c.Policy effective period 01/01/2024 to 12/31/2024 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: © A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. El B.Only the following class or classes of employer's employees: Under penaiiy of perjury,I ce_Mi thaat I am Wa.rtthonzed representative or I'icensed agent ttf the 6n uura—n66—cam et'refrenced a6ov -ancf Fai the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 3/1212024 By ' r D gne (S4natuce of insurance c,arder's authorized represemative or NYS Licensed Insurance Agent of that insurance carri ) Telephone Number 516-829-8100 Name and Title Richard White Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 413,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220, Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit,PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(only if sox 4B,4C or 5B have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) 11111111"1°°�u°11°°1°1°��"111°����d°1IIII Additional Instructions for Form D13-120.1 By signing this form, the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in Box 1 a for disability and/or Paid Family Leave benefits under the NYS Disability and Paid Family Leave Benefits Law.The insurance carrier or its licensed agent will send this Certificate of Insurance Coverage(Certificate)to the entity listed as the certificate holder in Box 2. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in Box 3c,whichever is earlier. This Certificate is issued as a matter of information only and confers no rights upon the certificate holder.This Certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This Certificate may be used as evidence of a NYS disability and/or Paid Family Leave benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or Paid Family Leave benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand and twenty-one, the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand eighteen, the payment of family leave benefits for all employees has been secured as provided by this article. D13-120.1 (12-21)Reverse Client#:23825 BINDERPO DATE(MMIDD/YYM ACORD.. CERTIFICATE OF LIABILITY INSURANCE 09/22/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holderis an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL SU R .. provisions,.....w... .. ...rs ..._ ... INSURED or be- endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). Amaden Gay Agencies,Inc. PHerN em PRODUCER chuerl _,.... _ N .. Kirnberl Y 9 Arc Ne,!r,�..d;631 324-0041 .. ... . �:t ...._...1 c N� 63 11 Gay Road �t�IL amadengay coin P.O.Box 5004 INSURER S AFFORDING COVERAGE NAIC# East Hampton,NY 11937 P INsuRERA:Valley Forge _w INSURED wsuRER6 West American Insurance ompany Continental Insurance C ompa Binder Pools Inc INSURERC min i ' .. nY 44393 PO Box 1960INSURER D:Ohio SecurityInsurance Company 24082 Shelter Island,NY 11964 INSURERE: ,......... �..._. INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN .. µ .v AOD $Xf1 .... POLICYy POLICY EYL F IMPPOlLwaICnY/Y EYXYPY) LIMITS INSURANCE NUMBER A X COMMERCIAL GENERALLIABILITY X X 5084911313 9/25/2023 0912512024 EACH OCCURRENCE $1 000000 CLAIMS-MADE ❑X OCCUR f" S L ENTED $100 000— - y......_ ed:1,000 MEDEXP Anyonio n $ 0s.000 . X PD D ....... ,m 15 . &ADv INJURY $1�,000�000 GEN L AGGREGATE LIMIT ...._.. _....... .. .. 2 000OOO APPLIES PER: GENERAL AGGREGATE $ :tooT�Ll ICY JEC�TPHS'' LOCAUTOMOBILE LIABILITY X BAS60950488 5/29/2023 05/29/202 I R: $ _'� c,ctMBUNI�$INt�LE LIMtT 1 000,000 BODILY IN ANY AUTO JURY(Per person) $ ............ ...... w ........... ......... ......_.. OWNE AUTOS ONLY ASUCTFDULED BODILY INJURY(Per accident) $ ..X AUTOS ONLY X HIRED NON-OWNED PROF TRTY DFMAC'E X .-�.. ._..... AUTOS ONLY �;Pfac�,aTiduavti)................._..w.�,.,........_.__w$ ._.,_..... .._..a .,.., X rive Oth Car I __ _.._ �� $ B X UMBRELLA LIAB X OCCUR__ X X 5086496894 ..w 9/25/2023 09/25/202 .,,EACH OCCURRENCE $1y000 0,,,,,,,,,00 .... ........... EXCESS LIAR CLAIMS-MADE AGGREGATE A 000 000 .......... ..._.....__ . $10000 . ..,_..... .......!.... .,� ........ ... ....... TAT LITE � OTH $ WORKERS ...0 COMPENSATION EMPLOYERS' ABT Y XNW60950486 0/01/2023 10/011202 PER I OO ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.DISEASE EMPL "'$�'LOOOLO OFFICERIMEMBEREXCLUDED? � N/A (Mandatory in NH) OYES $1000,000 If yes,desraft under E.L.DISEASE DESCRIPTION OF OPERATIONS below �Eq POLICY LIMIT $1 OOO OOO ­1 1 - DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate Holder is an additional insured as required by written contract. CERTIFICATE HOLDER. CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 Main Road ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S79950/M79930 KLH STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name and address of Insured(Use street address only) lb.Business Telephone Number of Insured 631-749-2110 Binder Pools,Inc. lc.NYS Unemployment Insurance Employer Registration PO Box 1960 Number of Insured Shelter Island,NY 1 l 964 1 d.Federal Employer Identification Number of insured or Social Security Number Work Location of Insured(Only required if coverage is specifically 11-3368250 limited to certain locations in New York State,i.e.a Wrap-Up Policy) 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Liberty Mutual Insurance Town of Southold 54375 Main Road 3b.Policy Number of entity listed in box"la": PO Box 1179 XWW60950488 Southold,NY 11971 3c. Policy effective period: 10/01/2023—10/01/2024 3d. The Proprietor,Partners or Executive Officers are: included. (Only check box if all partners/officers included) (X)all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The Insurance Carrier will also notes the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices maybe sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c'; whichever is earlier. Please Note:Upon the cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: _James Amaden (Print name of authorized representative or licensed agent of insurance carrier) " W 09/22/2023 Approved by: (Signature) (Date) Title: AGENCY PRINCIPAL Telephone Number of authorized representative or licensed agent of insurance carrier: 631-324-0041 Please Note. Only insurance carriers and their licensed agents are authorized to issue the C-105.2.form. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) aLw_wv�: itte.ou Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department,board,commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employee-, in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits,shall not issue such permit unless proof duty subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter.Nothing herein,however, shall be construed as creating any liability on the part of such state or municipal department,board,commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department,board,commission or office authorized or required bylaw to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter. C-105.2(9-07)Reverse d rn a m O1 0 33 N U) O r j } GO C LLJ J O LC U r O p N 4 N J uj to �r . Z �Oao a m oao O LU u7 I N m O pp N m o N o V o N L } N � (n - 2Z S1 ����11 M x� y d � EM 000000 O c UAL' V 2 0 � ....1. N C N N �[vNN(n(CNN 'O N N 1 CO jnC n p O ¢ �j v�wwwwww 4 O r = F W nN Ufl) m00 0, lxw� W :2CL .,,.,............. ff1 tW+{ 3r E �' O LU O 11> iiS a 66c U way �u 2111 IN v O Z it w a� `'gyp Ca j- " OF TL Z' a w ull-z z C z o g — ` "' HR �0 0 I III z Z W U Z P r � W . I zo r z » O J J P O 0000 0 Q OOccc.[9[000� V 04 W d d K Z W W U (^�' w mW W UJ W 0 z z(D co N W Z0=000 J J J WaWWWC aJ CO U)U)U) w 0KO000N w y �z�� 06 w Ow0000 ��u~i=ncw�U-U- a0-a I� w i = (nI—QQU' QQQdQQQ I �o N N .0 Q � 7 N O',4 U1� I ISSUED: 05292024 ZONING BOARD-REVISION 2 4 ' SNOWDoN F I Consulting ArchitectlDesigner SNOWDON II LTD 85 Willow Street#71 Orient,NY 11957 DAVID SNOWDON-JONES (T)212 518 1818 (E)dsj@snowdon.us r D"arbnent of Buildings-Denial Request-051 I 1 0112023 tail REVISION I-091071=3 REVISION 3-01118rM4 REVISION 5-011292024 ZBA/HPAS-BUILT r I _ -05/29202 s REVISION 5 4 AS43UILT FRAMING REVISION 5-05292024 2BA REVISION 2 _�,yPROPOSE09'z19'� DryWeu I `. 32� �2'�57^ 14' � -I WOOD DECK —PRO—POSED D I s ; Ell �i a I t-2• ;i '^ Address `t t - 1,1j txcua mF- I 585 Orchard Street Orient,NY ent 9 P o Poci E ui m - 11957 i ; i j- Description 3 HOME REMODEL I Proposed First Floor Site Plan View ENGINEER 3/16 in=1 ft j Nick Mazzaferro P.E. _ PO Box 57,Greenport,NY 11944 ZONING CHART LOTSIZE 9,566 SQ-Fr (T)516 457 5596 HOUSE 1053 SQ.Fr (E)nickmazzaferro@verizon.net GARAGE 244 SQ.Fr 5. Of NEB t PROPOSED POOL"a SQ.FT PROPOSED DECK171 SQ.FT - _ \�° TOTAL LOT COVERAGE 1 916 SO Fr 20% t ' ' _— OUSTING GFA 1,628 SQ.FT - I PROPOSED GFA 1.998 SQ.FT = m ALLONED GFA PER CODE21D0 SQFi� A-1.2 Floor Plans Proposed Site J `` SCALE:1/4—V-0° i ISSUED: 0512912024 ZONING BOARD-REVISION 2 € o "g Al ~\ r2l M<<OO ZOo90S aoo _ N ¢ • a 1 �o\ a Consulting ArchitecttDesigner X a oa ;� WyW � x E•ir m;j! SNOWDON II LTD < o 3 C' g�= Q i S € p = * 85 Willow Street#71 3ON33 o !! 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